Heel spur: definitions, symptoms, solution
The heel spur, also known as plantar fasciitis or Lenoir's spur, is a painful condition that affects the underside of the heel. This condition is often caused by inflammation or a tear of the plantar fascia, a thick ligament that connects the heel bone to the toes. People with a heel spur generally experience sharp, stabbing pain when walking or running.
What is a heel spur?
The calcaneal spur corresponds to a bone growth at the level of the calcaneal tuberosity. The muscles on the sole of the foot, called intrinsic foot muscles, and the plantar aponeurosis insert into the calcaneal tuberosity. The calcaneal spur develops along the axis of the plantar aponeurosis and is visible on side-view foot X-rays. When a bone growth extending more than 2 mm in length is seen coming from the calcaneal tuberosity, it is referred to as a calcaneal spur.
Location of a heel spur
The calcaneal spur is therefore located at the base of the heel, on the plantar side of the calcaneus at its tuberosity. Studies conducted do not agree on the location of the calcaneal spur; it may be situated at:
- the insertion of the intrinsic muscles of the foot on the calcaneus
- the insertion of the plantar aponeurosis on the calcaneus
- outside of these two structures, on the calcaneus, under the plantar aponeurosis.
The symptoms of heel spur
The main symptom is pain, which occurs under the heel. When faced with heel pain, also called talalgia, we perform X-rays of the feet and ankles, which may show a heel spur on the lateral views. CT scans and MRI can also reveal a heel spur, which is frequently associated with a thickening of the plantar fascia.
In some patients, we observe the pain radiating towards the arch of the foot or even the back of the leg. The intensity varies considerably: some people feel only mild discomfort, while others are completely unable to put their foot on the ground normally.
Walking becomes problematic. You will unconsciously adopt a modified gait, slightly dragging your foot or limping to avoid full weight-bearing on the painful heel. This compensation can generate secondary tension in the knees, hips, or back.
What are the causes of heel spurs?
Several factors contribute to the onset of this condition. We systematically identify them to adapt our therapeutic strategy and prevent recurrences.
| Cause | Details | Key statistic |
|---|---|---|
| Age | Loss of tissue elasticity and changes in gait. | 52% of patients after age 60 |
| Overweight and obesity | Increased pressure on the heels and strain on the plantar fascia. | Up to 82% of overweight patients |
| Foot morphology | High or flat arches creating tension on the plantar fascia. | — |
| Sports activities | Cumulative microtrauma due to repetitive impacts. | — |
| Prolonged standing | Prolonged standing on hard surfaces promoting inflammation. | — |
| Inappropriate footwear | Insufficient support or disturbed foot biomechanics. | — |
| Rheumatic diseases | Osteoarthritis and arthritis increasing prevalence. | 80% osteoarthritic, 70% arthritic after age 60 |
| Female predominance | Women are more affected than men. | 17% of women vs 9% of men at age 40 |
How to diagnose a heel spur?
At La Clinique du Pied, the diagnosis of heel spur is based on a methodical approach combining clinical examination and medical imaging.
- Clinical examination: Dr. Schramm performs a careful palpation of the heel to precisely locate the painful areas and identify the characteristic tenderness at the insertion point of the plantar fascia.
- Medical interview: We will ask you about the circumstances of the pain onset, its intensity at different times of the day, your professional and sports activities, as well as your medical history, in order to guide the differential diagnosis.
- Lateral foot X-ray: As the reference examination, it visualizes the bone growth, assesses its size, and clearly reveals the bone formation extending from the calcaneal tuberosity along the axis of the plantar fascia.
- Ultrasound or MRI: Prescribed if necessary, these additional tests make it possible to examine the soft tissues, detect thickening of the fascia, signs of inflammation or partial tears. MRI is particularly useful for distinguishing the heel spur from other conditions with similar symptoms.
The differential diagnosis excludes other conditions such as ankle arthritis, heel bursitis, isolated inflammation of the Achilles tendon, or a stress fracture. Each requires a specific therapeutic approach.
Conservative treatments for heel spurs: relief without surgery
At La Clinique du Pied, our approach always prioritizes non-surgical treatments as the first option. More than 90% of our patients achieve significant improvement with these methods, applied in a combined and rigorous manner.
We advise you to temporarily stop traumatizing activities (running, impact sports, prolonged standing). This period generally lasts between 1 and 3 months depending on the severity of your case. During this time, favor swimming or cycling, which place minimal strain on your heels.
A podiatrist makes these orthotics after analyzing your posture and gait. They evenly distribute pressure under the foot, support the arch, and reduce stress on the plantar fascia. At La Clinique du Pied, we observe a notable pain reduction in 70% of patients provided with the appropriate insoles. While waiting for your custom orthotics, gel heel pads available at pharmacies can provide temporary relief.
Daily stretches of the plantar fascia and calf (triceps surae) help reduce the mechanical tension responsible for inflammation. We recommend specific exercises to be performed morning and evening, notably with a tennis ball under the arch. Deep transverse massages performed by the physical therapist also relieve inflamed areas.
This non-invasive technique consists of applying high-pressure impulses to the painful area to stimulate local blood circulation and help break down calcifications. The protocol usually includes 3 to 5 sessions spaced one week apart.
Whether taken orally or applied locally, they effectively relieve acute pain. However, we prescribe them for limited periods to avoid side effects. These medications treat the symptom but do not act on the underlying cause.
We perform this injection precisely at the site of inflammation, under ultrasound guidance, for pain that is resistant to other treatments. The powerful anti-inflammatory effect usually provides rapid relief, but we limit the number of injections to 2 or 3 at most to protect the tissues.
Applying cold for 10 to 15 minutes several times a day reduces inflammation and calms pain. Conversely, some patients find relief with heat, which relaxes contracted muscles and fascia. We recommend trying both approaches to identify which works best for you.
Simple exercises like picking up a towel with your toes or doing eccentric calf contractions accelerate healing. These movements stimulate tissue reconstruction and improve the overall biomechanics of the foot.
Heel spur surgery: when does surgery become necessary?
The indications for a calcaneal spur surgery concern patients experiencing persistent, disabling pain that significantly limits their daily and professional activities, despite well-conducted medical treatment. We observe that severe nighttime pain, inability to walk normally, or the impossibility of resuming professional life justify this procedure.
At La Clinique du Pied, Dr. Schramm systematically favors minimally invasive and percutaneous techniques. These modern surgical approaches offer several advantages over conventional surgery: smaller scars, faster recovery, reduced post-operative pain, and limited risk of complications.
Procedure of the operation
The intervention is mainly aimed at releasing the plantar fascia (partial fasciotomy) to relieve excessive tension. In some cases, we also remove the bony spur when it compresses the surrounding tissues. The surgery is performed under regional or general anesthesia depending on your medical situation.
Our expertise in foot surgery allows us to precisely adapt the technique to your anatomy and needs. We take into account the shape of your foot (flat or high-arched), the degree of muscle contracture, and the condition of the plantar fascia to choose the optimal surgical procedure.
Heel spur, plantar fasciitis, and fascia inflammation: what are the differences?
These three terms often generate confusion among our patients. Let's clarify this topic together.
- Plantar fasciitis (or plantar aponeurositis, two equivalent terms) refers to the inflammation of the plantar fascia, the membrane that supports the arch of your foot. This inflammation occurs after repeated microtrauma, excessive strain, or prolonged tension. You will then experience sharp pain, particularly upon waking up.
- The heel spur is the consequence of this chronic inflammation. Faced with persistent irritation, your body gradually deposits calcium on the lesions to try to stabilize the area. This calcification forms the characteristic bony outgrowth.
At La Clinique du Pied, we observe that 85% of patients with a heel spur also suffer from plantar aponeurositis. The reverse is not systematic: you may develop painful plantar fasciitis without the formation of a visible spur.
FAQ
By correcting certain contributing factors such as managing excess weight, stretching the posterior muscle chains, and addressing muscle atrophy in a flat foot.
It is located at the base of the heel, at the plantar tuberosity of the calcaneus, where the plantar fascia and the intrinsic muscles of the foot attach.
Your general practitioner can treat heel spurs associated with heel pain. A rheumatologist can manage painful heel spurs in the context of inflammatory joint diseases. Finally, if the medical treatment is ineffective, you can consult an orthopedic surgeon.